How to Avoid Getting Screwed -Healthcare Costs, Mole Removal

My GF has some some odd shaped 3d moles on her back. She's knows she needs to get them removed and get lab work done, etc.

She called up Kaiser Permanente (our health insurance company) to ask how much it will cost. Apparently, the going rate is $500-$900 to scrape off 1 mole with a scalpel. She has roughly 15-20 that she needs removed, which means she'll hit our annual $5k out of pocket maximum.

Is there any kind of cash discount we should look into with out of network dermatologists? Should we call around and ask for a cash/volume discount? The entire process to remove 15-20 moles takes way under 1 hour.

In conclusion, fuck the US healthcare system. No, I'm not posting pics for you dirty bastards :FIREdevil

Yeah, we really don't need pics of the mole.
Booze + yank it out = solved.

http://www.thailandmedtourism.com/Me...c-Laser-Center

As far as I know, if you're paying out of pocket, Thailand is the place to go.
You may be able to afford a nice vacation, and get all the work done, for the same it would cost you here with insurance.

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Originally Posted by Kevo

Should we call around and ask for a cash/volume discount?

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Yes. I went years without health insurance, and any time I needed to see the doc (including dermatologists), dentists, etc., I'd tell them ahead of time I was paying cash and wanted to know the lowest price they could help me out with. That always got things to at least half off. Even after I had insurance, I'd continue working that way, saying I would not be using insurance. It's a win-win, since they save money not having to spend so much in administrative costs dealing with your insurance company, and you save money! Also, since I didn't need anything major like surgery, I'd shop around, calling around to see who would work with me the most. Doctors have honestly cost me very little throughout my entire adult life by working it this way.

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Originally Posted by Kevo

...She called up Kaiser Permanente (our health insurance company) to ask how much it will cost. ...

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do you have some kind of weird KSR plan? HDHP or some such? In CA KSR is mostly an HMO so you only pay office co-pays + a deductible for a procedure.

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Originally Posted by jfost

do you have some kind of weird KSR plan? HDHP or some such? In CA KSR is mostly an HMO so you only pay office co-pays + a deductible for a procedure.

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It's an HMO with $1,500/year deductible for families and 20% coinsurance.

We are looking at what will likely be a $10k+ bill after lab work is completed, so we'll be out of pocket at least $2k.

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Originally Posted by Kevo

It's an HMO with $1,500/year deductible for families and 20% coinsurance.

We are looking at what will likely be a $10k+ bill after lab work is completed, so we'll be out of pocket at least $2k.

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there is no way to get removal + labwork for less out-of-network, and plus you would be done for the year in January so anything else is "free"...

edit: check the policy again too, it might be something like $500 per individual/$1500 family and the associated labwork with the removal may not carry a coinsurance amount. You probably accounted for this already in your orig. quote above - but just to be sure...

Do you know that they need removed? As in a derm said so? I'm one that had to see the derm routinely, and what I thought needed to go turned out to be totally normal. Everyone is different, and even though some of my moles were raised ect, they are perfectly healthy. A tiny freckle I never noticed went, precancerous. When you say 15-20, it sounds like me, all worried because I had a handful, but turns out its fine. I did have 2 tested that i removed for piece of mind only to find doc was right. And he was right about the freckle too.

Edit: 10k?!!! It cost me$100 per mole for testing, and that was them sending it to Denver (a long ways away) for some lab cracky to dissect and test everything. That means 2k for 20. And 8k to remove is a rip off too.

pay for the botox and use insurance for removal/labs

You can get an exacto knife and a bottle of rubbing alchol from Amazon for 10 bucks or so.

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my phone is better than yours.

How to avoid getting screwed by health care costs? I don't think that's possible.

Another little known fact is that you don't NEED your doctor to send your samples (blood, moles, urine, whatever) to the lab for testing. Believe it or not, you can get that stuff to the labs yourself and save a bundle! I've used http://www.healthcheckusa.com/ before, and it's insane how cheap you can get lab work done. Remember, a lot of the costs of doctors visits includes administrative costs, couriers to deliver the samples, and so on. What so many people don't know is that you are entitled to take your healthcare into your own hands and cut out some of the middlemen!

By paying cash for my medical expenses, and doing a bit more work on my end, healthcare has not cost me much. I know everybody dogs our tard-o American healthcare system, and I do agree it stinks for a lot of reasons, but one of the reasons it costs people so much is simply because they are uniformed consumers and the system takes full advantage of them. I'm not talking cancer patients here, but average Joes who just need routine stuff or the occasional injury.

Check out this link from the broker who hooked me up with my insurance plan: http://www.c-ainsurance.com/smartcon...umerguide.html
Some REALLY good information there. He once told me how he even negotiated his double-bypass heart surgery he got a few years back. Only cost him like 15k compared to the almost 100k they told him originally. He paid cash (in installments I believe) directly to the hospital, and skipped using insurance all together.

I personally have followed the tips on that website, and it has indeed saved me a tremendous amount of money. As a consumer who wants to avoid getting screwed, it's all about learning how to work the system.

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Originally Posted by Sicks

Do you know that they need removed? As in a derm said so? ....

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This is my question too. I have a lot of raised moles on my back. Docs have never said anything about removing them. They look at them and pronounce them normal.

My dermo won't remove more than three at a time. So your also looking at multiple visits.

http://www.youtube.com/watch?v=QEExYuRelbg

triple nipple perhaps?

one can only hope.....

These are all apparently the bad ones. Barely 3D, but definitely not symmetrical

I think we may have to bite the bullet and pay up.

You could always move to Canada.

Go to the doc and tell them you want some moles removed. Then tell them your right knee is bugging you and you would like it replaced. While their at it they might as well replace the left one and look at the hip. Before leaving ask for some good prescription drugs.

Once all is removed/replaced don't wait for or worry about a bill, there won't be one.

Has she tried seeing her PCP? They can take off moles...

Vet?

Paging hutash...

If its an option, you might want to consider the scarring issue and look at laser excision.

If you get them cut off you get scars... the removal can be performed scarlessly w/ the right laser. I think you can do punch biopsies on all of them at kaiser and then perform laser excisions elsewhere. Mrs. Patches and I do a lot of cosmetic laser work,mostly high-end aesthetic procedures but we do mole removals too, they are at most $100 each (and usually less esp. in quantity) but we need a derm to say they are non-dangerous first.

Not sure why cutting them out costs so much. Scalpels cost a nickel apiece vs. our laser cost more than a house.

I'm not a doctor though, so better listen to your derm.

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Originally Posted by Kevo

My GF has some some odd shaped 3d moles on her back. She's knows she needs to get them removed and get lab work done, etc.

She called up Kaiser Permanente (our health insurance company) to ask how much it will cost. Apparently, the going rate is $500-$900 to scrape off 1 mole with a scalpel. She has roughly 15-20 that she needs removed, which means she'll hit our annual $5k out of pocket maximum.

Is there any kind of cash discount we should look into with out of network dermatologists? Should we call around and ask for a cash/volume discount? The entire process to remove 15-20 moles takes way under 1 hour.

In conclusion, fuck the US healthcare system. No, I'm not posting pics for you dirty bastards :FIREdevil

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The going rate so far as I know is about $100 a mole, at least around here. The allowable amount per mole goes way down after five, so most docs will only do five or so at once. One problem with doing more than five is that it becomes really hard to keep the specimens straight. If one comes back ca, you want to know exactly which one.

Path charges are more-I'm talking about the office and doctor charges.

I'm with you that the system is fucked. Over the years I've paid a shit ton in insurance and co-insurance deductibles etc. I know do a little better now that my wife has a government job. I assure you that $2K out of pocket for a fairly major procedure is not out of line these days.

Brings up the question, what is affordable health care?

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Originally Posted by skinnyskier

The going rate so far as I know is about $100 a mole, at least around here. The allowable amount per mole goes way down after five, so most docs will only do five or so at once. One problem with doing more than five is that it becomes really hard to keep the specimens straight. If one comes back ca, you want to know exactly which one.

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The allowable amount they can charge, so they limit 5 per visit. Crock of shit, and the doctors should eat a dick.

After 5, you can have a few leftover weed baggies with numbers on them to keep track. fucking stoner doctors.

Check to see if your dermatologist can do the biopsies, it can save some money. Smart not to mess around with irregular moles, I had one that turned out to be a melanoma. For skin tags I've used a blowtorch and hot nail.:biggrin:

Get a second opinion.

Raised moles, irregular boundaries, irregular colors are certainly suspicious, but it doesn't mean you have to cut them all off. Assessment via dermascope or hand-held confocal microscope (e.g. Lucid VivaScope), possibly followed by biopsy on a couple of the worst looking ones is preferable to cutting them all off at once. This is coming from someone who is high risk for skin cancer and has a shit ton of moles.

OK, this has nothing to do with mole removal, but it does pertain to the first two items in the thread title, so rather than start a new thread thought I'd just post here. It's an interesting case story, and shows how even with insurance and following Doctor recommendations you can get screwed badly.

The patient: Amari Vaca, now 1, who was covered by a Cigna policy sponsored by his father's employer at the time.

Medical services: An 86-mile air-ambulance flight from Salinas to San Francisco.

Service Providers: Reach Medical Holdings, which is part of Global Medical Response, an industry giant backed by private equity investors. Global Medical Response operates in all 50 states and has said it has a total of 498 helicopters and airplanes.

Total bill: $97,599. Cigna declined to cover any part of the bill.

What gives: Legal safeguards are in place to protect patients from big bills for some out-of-network care, including air-ambulance rides.

You can listen to or read the full story here...

https://www.npr.org/sections/health-...ally-necessary

P.S.
Attachment 492159

"Patricia Kelmar, a health policy expert and senior director with the U.S. Public Interest Research Groups, noted, however, that hospitals could familiarize themselves with local health plans, for example, and establish protocol, so that before they call an air ambulance, they know if there are in-network alternatives and, if not, what items the plan needs to justify the claim and provide payment.

'The hospitals who live and breathe and work in our communities should be considering the individuals who come to them every day," Kelmar said. "I understand in emergency situations, you generally have a limited amount of time, but, in most situations, you should be familiar with the plans so you can work within the confines of the patient's health insurance.' "

What bullshit. In an emergency doctors have better things to do than figure out what documentation the patient's insurer might need. That's not what the medical record is for. It is also bullshit that the first hospital refused to support the appeal. Hopefully UCSF wrote in support. I could see telling the ER doc--look, you can support the appeal or we can subpoena you when we sue Cigna and you can spend a day in court testifying to the same thing.

The air ambulance bill was bullshit too. Mine from Reno to Sacramento was 27,000. (And it wasn't medically necessary but ambulance wasn't an option due to a blizzard and I was transferred because Renoun in Reno was charging Kaiser more per day than the flight.) In the olden days of health insurance, when every insurer paid every provider, the insurers and providers established acceptable fees for medical services including ambulances and air ambulances. Now the insurers only control costs for their network of providers, leaving out of network providers free to charge whatever they feel like with no control. Renoun billed Kaiser 400,000+ for my care. Kaiser paid a quarter of that and Renoun was glad to get it. (Under the new law the out of network provider has take the network rate but of course that only applies if the insurer doesn't deny coverage.)

Just whac them

Attachment 492246

seborrheic keratosis? Usually removal is elective.

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Originally Posted by old goat

The air ambulance bill was bullshit too. Mine from Reno to Sacramento was 27,000. (And it wasn't medically necessary but ambulance wasn't an option due to a blizzard and I was transferred because Renoun in Reno was charging Kaiser more per day than the flight.)

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To play devil's advocate, I spent a long time in the aeromed industry, our profit margins were slim/non-existent. It costs a lot of $$ to pay nurses, pilots, mechanics to be on call 24hrs a day and keep aircraft flying. Also really fucking rare to go by air "due to blizzard". Almost always the other way around, especially if it was a rotor transport. Helicopters like to fly into the side of mountains in blizzards.

And something stinks, you can not, per EMTALA, transfer a patient to another facility based on insurance reimbursement. It has to be higher level of care requirement or some other patient care concern, but not a financial decision.

Curious to know the details of this. Was this prior to 1985 (EMTALA)?

The past three years the AR fam has had quite a ride health wise, including a life flight, NICU stay and a cancer treatment. All in total billings came out to over 400k. All is now well.

I have never been more happy to pay just pay the out of pocket max each year. Even after 20 years of paying into the health insurance system I'm way ahead financially and its not close. I used to really think health care was a fucked system but I will tell you, I was really really happy to have the best healthcare in the world available at a moments notice when I needed it. In some ways I get why its expensive, you get what you pay for in a lot of ways. That isn't to say in some ways they are milking you as well, but that exists in literally every industry. I just paid a plumber 700 to fix what ended up being a sock my kid stuffed in a drain. Said plumber was in the house for all of 25 minutes. You can't tell me that isn't an egregious bill also.

The life flight was a total bitch to deal with but they eventually caved and took the insurance approved amount. That took two years of stress and countless hours on the phone working the system to get done but it got done. So definitely feel for that side, but at the same time, what are you going to do, say no?

Usually you can request to enroll in the air ambulance service until they load you up. Our nurses in the ER will ask patients or their family if they want to enroll in the air ambulance insurance if a flight will be needed.


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Originally Posted by MagnificentUnicorn

Usually you can request to enroll in the air ambulance service until they load you up. Our nurses in the ER will ask patients or their family if they want to enroll in the air ambulance insurance if a flight will be needed.

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The aeromedical insurance system is such a racket. You’re no doubt dealing with Airlift (I used to fly for them) and Life Flight Network. It used to be done to capture flights (call Airlift I have their insurance)…the bedside sign up was a phenomenon that started in about 2017 after Uber competitive for-profit programs started doing it, which then forced Airlift to do it as well. Then flight insurance rates plummeted.

FWIW I don’t think aeromed can balance bill Medicare/Medicaid so flight insurance is pointless. It’s only for third party insurance where you end up with the copay balance. That is all the insurance covers. Most flight companies also don’t let uninsured by flight insurance because again, it only covers the copay.

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Originally Posted by AdironRider

The past three years the AR fam has had quite a ride health wise, including a life flight, NICU stay and a cancer treatment. All in total billings came out to over 400k. All is now well.

I have never been more happy to pay just pay the out of pocket max each year. Even after 20 years of paying into the health insurance system I'm way ahead financially and its not close. I used to really think health care was a fucked system but I will tell you, I was really really happy to have the best healthcare in the world available at a moments notice when I needed it. In some ways I get why its expensive, you get what you pay for in a lot of ways. That isn't to say in some ways they are milking you as well, but that exists in literally every industry. I just paid a plumber 700 to fix what ended up being a sock my kid stuffed in a drain. Said plumber was in the house for all of 25 minutes. You can't tell me that isn't an egregious bill also.

The life flight was a total bitch to deal with but they eventually caved and took the insurance approved amount. That took two years of stress and countless hours on the phone working the system to get done but it got done. So definitely feel for that side, but at the same time, what are you going to do, say no?

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Insurance is a collective (can you say “socialism”?) process. I remember when my mother in law who had MS for 40 years also was diagnosed with Leukemia. She ended up in the hospital for well over a month and due to the skilled nursing and other extensive treatment her prior condition required she rang up in excess of $1mil. Luckily my FIL was on a health insurance plan from a golden parachute buy out in the 90s so between that and Medicare they had very little out of pocket expenses. The many of us pay for years into the system to help offset those costs. Well, and the execs need their ski homes too, right?

It sounds like your family had excellent health care but don’t confuse that with the “best health care in the world” trope. Singapore, Norway, the Netherlands, and another few dozen other counties have objectively better care than the good ol USA. For what we pay, we should have such a better system.

The system worked for me and I am happy to have had the access I did. Would I have liked it to be cheaper? Sure, everyone would. I also recognize the profit motive has led to the US leading the world in medical advancement and development over the past 100 years that those other developed countries take distinct advantage of. If the development costs were more evenly distributed globally that would certainly help the US system cost wise.

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I also recognize the profit motive has led to the US leading the world in medical advancement and development over the past 100 years that those other developed countries take distinct advantage of.

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Maybe we did, currently I don't think we do.

One thing I have already learned after dealing with Medicare deductibles is, never pay out of pocket for anything.

Wait until you are absolutely 100% certain you owe what is claimed.

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Originally Posted by Trackhead

The aeromedical insurance system is such a racket. You’re no doubt dealing with Airlift (I used to fly for them) and Life Flight Network. It used to be done to capture flights (call Airlift I have their insurance)…the bedside sign up was a phenomenon that started in about 2017 after Uber competitive for-profit programs started doing it, which then forced Airlift to do it as well. Then flight insurance rates plummeted.

FWIW I don’t think aeromed can balance bill Medicare/Medicaid so flight insurance is pointless. It’s only for third party insurance where you end up with the copay balance. That is all the insurance covers. Most flight companies also don’t let uninsured by flight insurance because again, it only covers the copay.

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We have Airlift NW(UW) and LifeFlight. Airlift isn’t too bad because it’s funded by UW Medicine/State.


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If the local pro's can't figure it out they medivac and they do it all the time

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Originally Posted by AdironRider

The system worked for me and I am happy to have had the access I did. Would I have liked it to be cheaper? Sure, everyone would. I also recognize the profit motive has led to the US leading the world in medical advancement and development over the past 100 years that those other developed countries take distinct advantage of. If the development costs were more evenly distributed globally that would certainly help the US system cost wise.

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then why is the USA 47th in life expectancy according to world-o-meter?